Hepatobiliary and Pancreatic: Hepatic nodules in a patient with familial adenomatous polyposis and colorectal adenocarcinoma

A 37-year-old woman presented with multiple episodes of rectal bleeding. Her vital signs were normal. Her body mass index was 21.6, and physical examination was notable only for fresh blood in the stool found on digital rectal examination. Laboratory tests showed mild anemia with 10.9 g/dL of hemoglobin. Her only medical treatment was oral contraception. Colonoscopy to identify the source of bleeding revealed multiple colonic polyps and two ulcerated lesions in the rectum and sigma, which biopsies confirmed to be adenocarcinomas. The patient underwent pelvic magnetic resonance imaging (MRI) for pre-surgical staging, which identified the two tumors: one confined to the sigma wall (T2) and the other in the rectum with extramural extension (T3), and enlarged mesorectal lymph nodes (N2). Thoraco-abdominal computed tomography (CT) for staging purposes identified two hepatic nodes in S7 and S6 iso-attenuating to the liver parenchyma in the arterial phase and low attenuating in the venous phase.